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Fracture Risk Factors

As risk factors, age and gender are the biggest drivers of fractures. Women are far more likely to have a fracture than men, in fact one in two women over the age of 50 will have a fracture in her lifetime. This is because women’s bones even at their best (age 25–30) are generally smaller and less dense than men’s bones. Additionally, women lose more bone density than men as they age because of the loss of estrogen at menopause. There is more research being done in men and we are finding that 25% of men over age 50 will have a fracture in their lifetime.

Other risk factors that increase your risk of fracture:

Smoking is a risk factor for fracture because of its impact on hormone levels. Women who smoke generally go through menopause at an earlier age. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, smoking was tagged as a risk factor for bone loss more than 20 years ago. Determining the full impact of smoking on bone health is complex, because other factors can be involved. Smokers, for example, often tend to drink alcohol more, exercise less, and have poor diets. The bottom line, most studies indicate, is that smoking increases fracture risk. Quitting may reduce the risk, but even cutting down may help.

Drinking Alcohol in excess can influence bone structure and mass. Research published by the National Institute on Alcohol Abuse and Alcoholism indicates that chronic heavy drinking during a person’s earlier years can compromise bone quality and may increase the risk of bone loss—and potential fractures—even after drinking has stopped. At this point there has been little formal research into how alcohol consumption interacts with other factors, such as smoking, exercise, and nutrition, but it appears that excessive consumption of >3 drinks a day affects vitamin D metabolism and the risk of falling.

Steroids (corticosteroids) are often prescribed to treat chronic inflammatory conditions, such as rheumatoid arthritis, inflammatory bowel disease and chronic obstructive pulmonary disease (COPD). Unfortunately, the need to use them at increased doses can frequently cause bone loss and fractures. These unwanted side effects are dose dependent and are directly related to the ability of steroids to hinder the formation of bone, curtail absorption of calcium in the gastrointestinal tract, and increase the loss of calcium through the urine. In fact, bone loss occurs more rapidly with steroid use.

Rheumatoid Arthritis – In this debilitating autoimmune disease—which strikes two to three times more women than men—the body attacks healthy cells and tissues around the joints, resulting in severe joint and bone loss. Steroids, such as Prednisone, may make life easier, but they can also trigger bone loss as discussed under “steroids”. And, adding to the complexity, the pain and poor joint function reduce activity levels, further accelerating bone loss and fracture risk.

Other Chronic Disorders – Celiac disease, Crohn’s disease, and ulcerative colitis, are often linked to bone loss which can be accelerated by their frequent and necessary treatment with steroids. A common factor in all these conditions is the gastrointestinal tract’s reduced ability to absorb enough calcium to create and maintain strong bones. The Crohn’s and Colitis Foundation of America notes that 30 to 60 percent of people with inflammatory bowel disease may also have low bone density.

Diabetes patients with Type 1 diabetes often have low bone density, though researchers are not sure why. Typical onset of Type 1 diabetes is in childhood when bone mass is building, and some sufferers also have celiac disease. The vision problems and nerve damage that frequently accompany diabetes can contribute to falls and related fractures. In Type 2 diabetes, typically with onset later in life, poor vision, nerve damage, and inactivity can lead to falls; although bone density is typically greater than with Type 1 diabetes, bone quality may be adversely affected by metabolic changes due to high blood sugar levels.

Previous Low Impact Fractures doubles the risk of having another fracture. Spine (vertebral) fractures are strong predictors of more spine fractures to come, but these fractures often occur so slowly that there is no painful “event”. Women should ask for accurate height measurements at their annual medical examinations, since loss of height more than an 1½ inches could indicate the presence of spine fractures.

Family History of Hip Fracture increases the risk of hip fractures in their children.

Reviewed: 3/20/19

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What to know about bone health
and fracture prevention during COVID-19

  • Remove fall dangers in your home.
  • Stay physically active, and at least 6 feet away from others.
  • Eat for proper nutrition, and take a supplement if needed to get enough calcium and vitamin D.
  • Stick with your osteoporosis medicines and ask your doctor for extra if you’re unable to go to the pharmacy.
  • If you are due for Reclast, there is little concern about delaying for a few weeks or months.
  • If you take Prolia or Evenity injections, don’t miss your appointment.  Some facilities offer “drive-through” injections. Check with your doctor.
  • Bone density testing can be postponed, if necessary.
  • Speak with your doctor about the possibility of telephone and video visits.

The Centers for Disease Control and Prevention has a page with steps you can take to reduce your risk of catching the virus if you have a chronic illness.

Be well. We are here for you if you have any questions.